Search PubMed⌕ Search

Biomedical subjects

C Redmond

Publications and source records attributed to C Redmond.

At least 91 records · Page 5Linked to original sources
PubMed1981

Treatment of primary breast cancer with chemotherapy and tamoxifen.

We studied the possibility that the addition of tamoxifen to L-phenylalanine mustard combined with 5-fluorouracil enhances the benefit from the latter two drugs that has been observed in women with primary breast cancer and positive axillary nodes. Recurrence of disease was reduced at two years in patients given the three-drug regimen whose tumor estrogen-receptor levels were greater than or equal to 10 fmol. Among patients greater than or equal to 50 years old treatment failure was significantly reduced (P less than 0.001): by 51 per cent in those with one to three positive nodes and by 64 per cent in those with four or more. Higher receptor levels were associated with a greater probability of disease-free survival. Patients less than or equal to 49 years old were less responsive: those with one to three positive nodes received no benefit from tamoxifen at any receptor level, whereas those with four or more appeared to have reduced treatment failure associated with higher receptor levels. This adjuvant chemotherapy is not indicated in patients less than or equal to 49 years old whose tumor receptor levels are below 10 fmol; there is a suggestion of benefit in patients greater than or equal to 50 years old whose levels are low.

Age Factors↗
PubMed1981

Correlation of primary breast cancer histopathology and estrogen receptor content.

We studied the association of estrogen receptor (ER) with several histologic variables that correlate with breast tumor differentiation and with patient prognosis. Contingency table analysis revealed highly statistically significant correlations between ER content and histologic and nuclear grades, tumor necrosis, and the degree of elastosis and lymphoid cell infiltration. ER positive tumors were more likely than ER negative tumors to demonstrate histological evidence of tumor differentiation. All tumors with histologic grade 1 or nuclear grade 1 (best differentiated) were ER positive or borderline positive. Eighty-nine percent of ER negative tumors were histologic grade 3 and 78.4% were nuclear grade 3 (poor differentiation). ER positive tumors were also correlated with absent tumor necrosis, higher elastic content, and absent lymphoid cell infiltration, all features of good differentiation. Medullary carcinomas were frequently (73%) ER negative, but no relationship between ER and other morphologic types of breast cancer or 9 other morphologic variables was found. ER appears to be a biochemical marker for the degree of differentiation of human breast cancer providing a rationale for the observed differences in biological behavior between receptor positive and negative tumors.

Axilla↗
PubMed1980

The contribution of recent NSABP clinical trials of primary breast cancer therapy to an understanding of tumor biology--an overview of findings.

Disagreement about local-regional management of primary breast cancer is related to differences in perception of the biology of the disease. Other factors are secondary and obscure the reality that all treatment must be related to biological considerations; otherwise, the basis for therapy is relegated to speculation and to personal experience. As a result of extensive laboratory and clinical studies during the past two decades, there has arisen an altered concept of cancer biology. The National Surgical Adjuvant Project for Breast and Bowel Cancers (NSABP) has made a major contribution to the change through findings from a series of prospective randomized clinical trials. That group of American and Canadian investigators has implemented a series of trials aimed at answering biological as well as clinical questions. Those studies have not only been concerned with defining proper local-regional treatment but have also pointed out the need for, and value of, systemic therapy when used in conjunction with operation. This report will provide an overview of past and present NSABP contributions and will consider those findings in relation to observations from other clinical trials of pertinence. It will emphasize that controversies concerning breast cancer management are related to biological issues that cannot be resolved by "populism" or appeals to emotion.

Adult↗
PubMed1980

Pathologic findings from the National Surgical Adjuvant Breast Project (Protocol no. 4). VI. Discriminants for five-year treatment failure.

Thirty-six pathologic and six clinical characteristics observed in 581 patients enrolled in protocol no. 4 of the National Surgical Adjuvant Breast Project were treated by radical mastectomy and were correlated with five-year treatment failure. The cases were initially stratified according to pathologic nodal status, the most important discriminant in breast cancer. The presence of tumor necrosis, poor tumor differentiation (histologic grade 3) and a tumor size > 4 cm were found by multivariate analyses to influence treatment failure in patients without nodal metastases. Prognosis was usually worse in individuals whose tumors exhibited all of these features than in those in whom only one or two could be detected. Although the sample size was small, life-table analysis also disclosed a highly significant relationship between treatment failure and a germinal center predominance pattern in regional nodes in this subset of patients. Except for this latter, these same discriminants were similarly noted to affect treatment failure in those patients with four or more nodal metastases but not those with only 1--3 positive nodes. A possible explanation for this inconsistency among nodal categories is discussed. Nevertheless, it is concluded that these rather easily measured pathologic parameters represent important discriminants for the prognosis and the design of treatment schemes and subsequent protocols for patients with breast cancer, particularly those without regional nodal metastasis. The findings amplify the importance of intrinsic tumor characteristics as well as possibly host factors in accounting for the clinical behavior of patients with breast cancer.

Breast↗
PubMed1980

Pathologic findings from the National Surgical Adjuvant Breast Project (protocol no. 4). VI. Invasive papillary cancer.

Although papillary forms of intraductal cancer are a common component of amny mammary cancers, invasive papillary cancer of the breast is relatively rare. Only 35 examples were encountered in the specimens obtained from 1603 women participating in a prospective randomized study of invasive mammary cancer. Contingency-table analysis disclosed that invasive papillary cancer, as opposed to the non-papillary histologic types, is significantly more likely to show circumscription, cytoplasmic oxyphilia, microcalcification, intermediate histologic grade, moderate or marked mucin and an intraductal component of papillary type. Although patients who have invasive papillary cancer are frequently judged by clinical criteria to have regional nodal metastases, in pathologic analysis these metastases are not commonly found and, if present, involve fewer than four nodes. There is a significant frequency of marked sinus histiocytosis in regional nodes. The lesion occurs with a significantly high frequency among non-Caucasian and postmenopausal women. Only three patients with invasive papillary cancer experienced treatment failure after five years of observation. Life-table probabilities showed that the treatment failure rate was significantly lower for the group of patients who had any other histologic type, and in this regard invasive papillary cancer was similar to the tubular and mucinous varieties. Although apocrine metaplasia, fibrous supporting stalks and cellular differentiation have been espoused as important criteria distinguishing intraductal papi-loma from intraductal cancer, these features were also not uncommonly observed in the examples of invasive papillary cancer studied. It is concluded that invasive papillary cancer represents a unique histologic type of invasive mammary cancer attendant with a favorable prognosis.

Breast Neoplasms↗
PubMed1979

1-phenylalanine mustard (L-PAM) in the management of premenopausal patients with primary breast cancer: lack of association of disease-free survival with depression of ovarian function. National Surgical Adjuvant Project for Breast and Bowel Cancers.

Breast cancer patients participating in a prospective randomized clinical trial who were less than or equal to 49 years of age, had positive axillary nodes, and who received prolonged 1-phenylalanine mustard (L-PAM) as an adjuvant to mastectomy continue (after 4 years) to demonstrate a significantly greater disease-free survival (p = .007) than do patients who received placebo. Benefit was achieved in patients who were less than or equal to 39 years as well as those who were 40-49 years of age. Those in the younger age group showed a greater improvement in disease-free survival at 4 years relative to their controls (32% vs. 69%; p = .01) than did those in the older age group (48% vs. 61%; p = .09). When patients were examined relative to their nodal status, a highly favorable effect was found to have been achieved with L-PAM in those with 1-3 positive nodes (54% vs. 86%; p = .006). Results indicate that both age groups were benefited. When considered over time, they demonstrate that a relatively greater effect was achieved in the younger women. While L-PAM failed to significantly alter the disease-free survival of those with greater than or equal to 4 positive nodes a slightly better effect was achieved in the group less than or equal to 39 years. Since adjuvant chemotherapy has been found to be more effective in premenopausal than postmenopausal women, it has been presumed that decreased ovarian function, as a result of the chemotherapy, is responsible for the findings. To support or repudiate that concept, information regarding serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2), as well as menstrual function, has been obtained from women receiving L-PAM or L-PAM plus 5-FU therapy. In contrast to findings relative to disease-free survival, ovarian function and menses were most affected in patients 40-49 years of age. Amenorrhea occurred in 73% of patients in that age group and in only 22% of those less than or equal to 39 years (p less than .001). Similarly, a significant increase in LH and FSH and a decrease in E2, all indicative of ovarian suppression, was observed only in the older group of patients. Thus, it is concluded that while ovarian suppression may account for some of the adjuvant chemotherapeutic effect in premenopausal women, the dichotomy of findings in younger and older premenopausal women relative to therapeutic response and ovarian function indicates that other factors could be responsible.

Adult↗
PubMed1978

Detection and significance of occult axillary node metastases in patients with invasive breast cancer.

Blocks of axillary lymph nodes from 78 patients with invasive breast cancer, which after "routine" pathological examination were regarded as negative for metastases, were step-sectioned at 20 u intervals. Occult metastases were detected in 24% of the cases. A significant association between such metastases and a lack of or slight degree of an intraductal carcinomatous component of the dominant cancer was noted. There was no relationship between occult metastases and 15 other histopathological and 3 clinical features investigated, including an average 5 year survival rate. Similarly there was no correlation between any of the possible discriminants investigated in the 24% of patients who have died of their diseases or are living with recurrence regardless of the presence of occult metastases. Factors accounting for the lack of universal survival in patients with Stage I (and those with occult metastases that might be designated as stage 11/2) remain enigmatic. It is concluded that attempts to detect occult metastases by extending histopathological methods may be more academic than practical or therapeutically significant.

Axilla↗
PubMed1978

The histopathology of mammographic patterns.

No significant correlation between the types of histologic alteration and various mammographic densities as described by Wolfe was found in specimen mammograms from 50 patients with cancer of the breast and a similar number with fibrocystic disease except for a greater incidence of fibrous mazoplasia in the "highest-risk" densities designated DY. This information is inconsistent with prevailing views that relate such risk for the development of mammary cancer to proliferative fibrocystic disease, vis-à-vis epithelial rather than stromal proliferation. This observation does not necessarily mitigate claims of risk attendant with various mammographic patterns, but indicates the need for further evaluation of this stromal alteration as a discriminant in this regard.

Breast Diseases↗